Permit _ CITY OF TIGARD PLUMBING PERMIT
: ' ' COMMUNITY DEVELOPMENT Permit#: PLM2016 00264
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/19/2016
T f i_;r R f3 g Parcel: 2S113AA00700
Jurisdiction: Tigard
Site address: 16416 SW 72ND AVE B5
Project: Stauffer Cisco Supply Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Capping(4)2"floor drains,(3)sinks/lays&(2)water closets. Relocate/replace(1)2"floor drain,(3)sinks/lays&
(2)water closets.Installation of(1)expansion tank&(1)water heater.
Contractor: DEAN WARREN PLUMBING&REMODELING INC Owner: PACIFIC REALTY TRUST
PO BOX 14701 ATTN: N PIVEN
PORTLAND, OR 97293 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-624-6300
PHONE: 503-236-4152 3
FAX: 503-296-2218
FEES
Quantity Description Date Amount
1 ea Expansion Tank 05/19/2016 $12.51
Specifics: g ea Fixture/Sewer Cap 05/19/2016 $225.18
1 ea Floor Drain/Floor Sink/Hub 05/19/2016 $25.02
Type of Use: COM 1 ea Sink 05/19/2016 $25.02
Class of Work: ALT 2 ea Lavatories 05/19/2016 $50.04
Type of Const: 2 ea Water Closet 05/19/2016 $50.04
Occupancy Grp: 1 ea Water Heater 05/19/2016 $37.52
Stories: 1 12%State Surcharge- 05/19/2016 $51.04
Plumbing
Total $476.37
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issuedy: /- r Permittee Signature: 001!
Call 503.639.4175 by 7:00 a.m.for the next available insp; ion date.
This permit card shall be kept in a conspicuous place on the job site u til completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures
Cityof Tigard Received 4,
ganrix, Date/By: 6 /1 / Permit No.: �,��/4-60244
iii 13125 SW Hall Blvd.,Tigard,OR 972 G v
c Date/By:
Plan Review \114 I �uP `6-00/65-
Phone: 503.718.2439 Fax: 503.598. Other Permit Na: J
1 I t..q R I y Inspection Line: 503.639.4175 � 7.015 Date Ready/By: Juris: la See Page 2 for
Internet: www.tigard-or.gov �Q1 Notified/Method: Supplemental information
' TYPE OF WORK rr 1''W((��o flhpiPS O FEE* SCHEDULE
0 New construction ❑Dern�l�giMG D\V For special information use checklist.
LL{J Description Qty. ] Ea. I Total
Addition/alteration/replacement 0 O New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
ID1-and 2-family dwelling RICommerciallindustrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder El Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: / C'-/f‘ , `-`�2 t-d Catch basin or area drain 18.76
City/State/ZIP: 7 rs ce. C/ ')Z � Drywell,leach line,or trench drain 18.76
S Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: L -,4 u e__ £[,e(-) ,5u poi_y Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: a CJ i 1'3/'f l X70 4::' Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
n Clothes washer 25.02
avyt0 d '� g.,•ti. Z 114-- Dishwasher 25.02
�
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank / 12.51 (Z,S
n ^� � Fixture/sewer cap 9 25.02
Name: /"eC / "')
_ I Floor drain/floor sink/hub X./ 25.02 /,. { iU
Address:
5-3 5� Ste- &ce 0 e /�^ "'y Garbage disposal 25.02
City/State/ZIP: 7/ .1 t'-a co_ S `7,22-(j Hose bib 25.02
Phone:(y ) C j 14.-ccOO Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
/� Olt_ /a7 6.,„,,„„4/ Medical gas(value:S ) Page 2
Business name: / t ]
Contact name: 1.-0_40 /z 4,c Primer 12.51
Roof drain(commercial) 12.51
Address: //��
/''O dg, h/•7Ct Sink/basin/lavatory 1 3)4 25.02 /5-1),12
City/State/ZIP: 0_7( . q 72_S 3 Solar units(potable water) 62.54
Phone:(y ) ?Jo gib•( Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet piC 2 25.02 foot GS
Water heater I 37.52 37,SZ
Business name: Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal 44: •31
Phone:( ) Fax:( ) Minimum permit fee: $72.50 ._----.
CCB Lie.: /5-4/5/7 Plumbing Lic.no. C-71(#0 Plan review (25%of permit fee)
State surcharge(12%of permit fee) 57.04/
Authorized signature: TOTAL PERMIT FEE z./76.37
Print name: }z„ a a Date: 3.i -/6 This permit application expires if a permit is not obtained within 180 days
�J rn after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:Building Permits PLMII-PernilApp.doc 1001 09 440-4616T(1002 COM WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1" 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer- 1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
each additional$100.00 or fraction thereof,to
Other Inspections or Fees Qty. Fee(ea) Total
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first S50,000.00 and 51.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive filas defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial 12 Any multipurpose fire sprinkler system.
Domestic El Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: 2
3.. Isometric or Riser Diagram
4 ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley _
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet 2 Z plumbing permit can be issued.
Urinal
Other Fixtures:
I:A Building\Permits\PLM F_PernitApp.doc 08/04/2011 2
Accumulative Sewer Tally
Tenant Name: Stauffer Cisco Supply ***CREDITS** SWR# N/A
t G n Et o Site Address: 16416 SW 72nd Ave PLM# 2016-00264
Parcel#: 2S 113AA00700
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptisery/Font 4 0 0 0 0 0
Bath: -"I'ub/Shower 4 0 0 0 0 0
-Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash: -Each Stall 6 0 0 0 0 0
-Drive through 16 0 _ 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher: -Commercial 4 0 0 0 0 0
-Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 4 8 1 2 -3 -6
-3 inch 5 0 0 0 0 0
-4 inch 6 0 0 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 HP) 16 0 0 0 0 0
-Commercial(to 5 HP) 32 0 0 0 0 0
-Industrial(over 5 HP) 42 _ 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 0 0 0 0
Living Unit 16 0 0 0 0 0
Oil Sep(Gas Station) 6 0 0 0 0 0
Rec.Vehicle Dump station 16 0 0 0 0 0
Shower: -Gang(per head) 1 0 0 0 0 0
-Stall 2 0 0 0 0 0
Sink:
-Lay/Bar-Non-Food Related 2 0 3 6 3 6 0 0
-Bradley 5 0 0 0 0 0
-Com/Sere/Uhl-Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 2 12 2 12 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 9 26 6 20 -3 -6
Current Fixture Value -6 divided by 16= -0.375 Current EDU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -6 divided by 16= -0.375 over (under) S (1,938.00)
Enter EDU Change Here -0.380 *
*Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes: ***CREDPI'S***
Authorized Name/Signature: Debbie Adamski Date: 5/19/2016
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\Building\Sewer Tally\Sewer I'allyShect_510O_070115.xlsx
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16416 SW 72ND AVE B5, TIGARD, OR, 97224
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00264
Chip Barnett
Violation Summary:
Inspector Contractor